Ó

Operative Dentistry, 0000, 00-0, 000-000

Influence of Emission Spectrum and

Irradiance on Light Curing of
Resin-Based Composites
CAK Shimokawa  B Sullivan  ML Turbino  CJ Soares  RB Price

Clinical Relevance
Clinicians should be aware that while broad-spectrum LED curing lights can enhance the
properties at the top of a restoration made of resin composites that contain ‘‘alternative’’
photoinitiators, the use of these lights could result in inferior properties at the bottom,
since little violet light reaches this area of the restoration.

SUMMARY Methods and Materials: Two prototype LCUs

Purpose: This study examined the influence of
different emission spectra (single-peak and
broad-spectrum) light-curing units (LCUs) de-
livering the same radiant exposures at irradi-
ance values of 1200 or 3600 mW/cm2 on the
polymerization and light transmission of four
resin-based composites (RBCs).
Carlos Alberto Kenji Shimokawa, DDS, MSc, PhD student,
Department of Restorative Dentistry, School of Dentistry,
University of São Paulo, São Paulo, Brazil
Braden Sullivan, BSc, research assistant, Department of
Dental Clinical Sciences, Faculty of Dentistry, Dalhousie
University, Halifax, NS, Canada
Mı́riam Lacalle Turbino, DDS, MSc, PhD, associate professor,
Department of Restorative Dentistry, School of Dentistry,
University of São Paulo, São Paulo, Brazil
Carlos José Soares, DDS, MSc, PhD, professor, Department of
Operative Dentistry and Dental Materials, School of Den-
tistry, Federal University of Uberlandia, Uberlandia, Brazil
*Richard Bengt Price, BDS, DDS, MS, FRCD(C), FDS RCS
(Edin), PhD, professor, Department of Dental Clinical
Sciences, Faculty of Dentistry, Dalhousie University, Hal-
ifax, NS, Canada
*Corresponding author: 5981 University Ave., Halifax, NS
B3H 4R2, Canada; e-mail: richard.price@dal.ca
DOI: 10.2341/16-349-L
that used the same light tip, but were either a
single-peak blue or a broad-spectrum LED,
were used to deliver the same radiant expo-
sures to the top surfaces of the RBCs using
either standard (1200 mW/cm2) or high irradi-
ance (3600 mW/cm2) settings. The emission
spectrum and radiant power from the LCUs
were measured with a laboratory-grade inte-
grating sphere coupled to a spectrometer, and
the light beam was assessed with a beam
profiler camera. Four RBCs (Filtek Supreme
Ultra A2, Tetric EvoCeram A2, Tetric EvoCer-
am T, and TPH Spectra High Viscosity A2)
were photoactivated using four different light
conditions: single-peak blue/standard irradi-
ance, single-peak blue/high irradiance, broad-
spectrum/standard irradiance, and broad-
spectrum/high irradiance. The degree of con-
version (N=5) and microhardness at the top
and bottom of 2.3-mm-diameter by 2.5-mm-
thick specimens (N=5) were analyzed with
analysis of variance and Tukey tests. The
real-time light transmission through the RBCs
was also measured.
Results: For all light conditions, the 2.3-mm-
diameter specimens received a homogeneous
2 Operative Dentistry
irradiance and spectral distribution. Although
similar radiant exposures were delivered to
the top surfaces of the RBCs, the amount of
light energy emitted from the bottom surfaces
was different among the four RBCs, and was
also greater for the single-peak lights. Very
little violet light (wavelengths below 420 nm)
reached the bottom of the 2.5-mm-thick speci-
mens.
The degree of conversion and microhardness
results varied according to the RBC (p,0.05).
The RBCs that included alternative photoini-
tiators had greater microhardness values at
the top when cured with broad-spectrum
lights, while at the bottom, where little violet
light was observed, the results were equal or
higher when they were photoactivated with
single-peak blue lights. With the exception of
the microhardness at the top of TPH, equiva-
lent or higher microhardness and degree-of-
conversion values were achieved at the bottom
surface when the standard (1200 mW/cm2)
irradiance levels were used compared to when
high irradiance levels were used.
Conclusions: Considering the different behav-
iors of the tested RBCs, the emission spectrum
and irradiance level influenced the polymeri-
zation of some RBCs. The RBCs that included
alternative photoinitiators produced greater
values at the top when cured with broad-
spectrum lights, while at the bottom, results
were equal or higher for the RBCs photoacti-
vated with single-peak blue lights.
INTRODUCTION
Camphorquinone is the most commonly used photo-
initiator in resin-based composites (RBCs), but it has
a yellow color that may influence the final color of
the restoration.1 This can be problematic if the
patient has bleached teeth or otherwise requires a
light-colored restoration. Consequently, some resin
manufacturers have started to use ‘‘alternative’’
photoinitiators, such as Lucirin TPO and Ivocerin.
These photoinitiators do not impart such a yellow
color to the final restoration, but they are most
reactive to lower wavelengths of light2 close to 410
nm compared to camphorquinone, which is most
sensitive to light at 468 nm, or below 320 nm.
Light-curing units (LCUs) that use light-emitting
diodes (LEDs) rather than halogen lights produce a
relatively narrow wavelength of light and deliver
little below 420 nm. Since they may not be able to
adequately activate these alternative photoinitia-
tors, some manufacturers have included in their
LCUs several different LED chips that emit light at
different wavelengths, thus producing a broader
emission spectrum.3,4 However, it is difficult to
achieve a uniform distribution of light at the tip of
the LCU, and this inhomogeneity can lead to
nonuniform polymerization of dental restorations.5-8
Another trend is to try to make clinical procedures
faster. Instead of using a 40-second light exposure
time, some manufacturers claim that their LCUs
deliver such a high irradiance that they can
adequately polymerize RBC restorations in as little
as one second. However, studies have shown that
light-curing RBCs for short exposure times is not
ideal.9-11 This is of concern because inadequate
photoactivation of the RBC can negatively affect
the properties of the restoration, resulting in a lower
degree of double-bond conversion and inferior me-
chanical properties.12-14 Also, the degree of conver-
sion of the resin has a direct correlation with
biocompatibility of the RBC restoration in the
mouth.15 Moreover, the irradiance of the LCU used
in the photoactivation of the RBC may affect the
polymerization kinetics, and a rapid polymerization
reaction may increase the polymerization contrac-
tion stresses and have detrimental effects on the
restoration.16,17
Since there are many different types of LCU
available, dentists should be aware of differences
that exist among units and the impact these
differences can have on the RBC. They should know
when it is appropriate to use each type of LCU.18,19
To provide the dentist with this information, this
study aimed to verify the influence on the polymer-
ization of four different RBCs with different emission
spectra from single-peak and broad-spectrum LED
units, which delivered either a standard irradiance
that is typical of most contemporary LCUs, or a high
irradiance typical of a powerful LCU. The null
hypotheses were the following:
1) There will be no difference between the degree of
double-bond degree of conversion and the Knoop
microhardness of RBCs achieved when light cured
with the single-peak blue or the broad-spectrum
curing lights.
2) There will be no difference between the degree of
double-bond conversion and microhardness of
RBCs when light cured under the standard
irradiance, or the high-irradiance conditions.
3) There will be no correlation between the degree of
double-bond conversion and Knoop microhardness
Shimokawa & Others: Effect of Curing Light Output on the RBC
values of RBCs when light cured using the
different exposure conditions.
METHODS AND MATERIALS
Four RBCs were used in this study: Filtek Supreme
Ultra—shade A2B (3M ESPE, St Paul, MN, USA),
Tetric EvoCeram —shade A2 (Ivoclar Vivadent,
Amherst, NY, USA), Tetric EvoCeram—shade T
(Ivoclar Vivadent), and TPH Spectra High Viscosi-
ty—shade A2 (Dentsply, Milford, DE, USA). They
were photoactivated using either a custom-designed
single-peak blue light or a broad-spectrum light,
both made by Ultradent (South Jordan, UT, USA).
The optics (lenses) in both units were identical, both
had a 9.6-mm tip diameter, and only the LED
emitters were different. The electrical current to
the LED emitters of both LCUs could be altered by
the user, thus allowing the units to deliver various
irradiance levels.
Characterization of the LCUs
The emitted radiant power and emission spectrum
were measured through a 2.3-mm-diameter aperture
into a FOIS-1 integrating sphere (Ocean Optics,
Dunedin, FL, USA) coupled to the USB 4000 fiber-
optic spectrometer (Ocean Optics). Before the mea-
surements, the system was calibrated using an LS-1-
CAL-INT calibration lamp (Ocean Optics). For each
light condition, five measurements of the spectral
radiant power emitted between 350 and 550 nm were
made. Using results from the integrating sphere, the
electrical current to the LED chip was adjusted so
that the same radiant exposure was delivered in four
exposure conditions: 1) single-peak blue light with
standard irradiance (SS), 2) single-peak blue light
with high irradiance (SH), 3) broad-spectrum multi-
peak light with standard irradiance (MS), and 4)
broad-spectrum multipeak light with high irradiance
(MH).
As previously described,20 to assess the radiant
power distribution across the LCU tip, the beam
profile analysis was made using a charge-coupled
device (CCD) digital camera with a 50-mm-focal-
length lens (SP620U, Ophir-Spiricon, Logan, UT,
USA) that was fixed at a predetermined distance from
the diffusing surface of a translucent ground-glass
target (DG2X2-1500, Thor Laboratories, Newton, NJ,
USA). A custom-made blue filter (International Light
Technologies, Peabody, MA, USA) was used to flatten
the spectral response of the CCD camera. The
photonic count received by each camera pixel was
calibrated with BeamGage version 6.6 software
3
(Ophir-Spiricon). The effect of the ambient light was
eliminated before the data collection by using the
UltraCal feature in the BeamGage software.
The image received by the camera was collected
using the BeamGage software 10 seconds after
activating the LCUs using the standard irradiance
conditions and three seconds after activating the
LCUs under the high-irradiance conditions. Color-
coded and calibrated irradiance images were gener-
ated using the mean values of emitted radiant power
that had been previously collected. The graphics
software program Origin Pro version 9.1 (OriginLab,
Northampton, MA, USA) was used to scale the two-
dimensional images that were then visually com-
pared.
Degree of Conversion
Degree of double-bond conversion measurements
were made in gray opaque molds that were 2.3 mm
in diameter and 2.5 mm in height. The molds were
filled with uncured RBCs and placed directly over
the diamond at the center of the Golden Gate
Attenuated Total Reflectance (ATR) platform (Spe-
cac, Orpington, Kent, UK) attached to a Tensor 27
Mid IR FT-IR spectrometer (Bruker, Billerica, MA,
USA). A Mylar strip was placed over the top of the
uncured resin and pressed flat with a glass slab. The
slab was removed and the specimen was exposed for
15 seconds using the standard irradiance level or
five seconds using the high irradiance level. These
exposure times delivered the same radiant exposures
to the RBCs. The mid IR spectra were collected for
five seconds before light curing and were recorded
continuously in real time for four minutes at a
resolution of eight wavenumbers and collection rate
of two scans per second. Five specimens were made
with each RBC and each light condition for a total of
80 specimens.
Knoop Microhardness
After the degree-of-conversion analysis, the speci-
mens were removed from the ATR platform. Twenty-
four hours after light curing the specimen, three
Knoop microhardness indentations were made in the
top and the bottom of each specimen, using a load of
15 gf for eight seconds in a microhardness-testing
device (HM 123, Mitutoyo, Kawasaki, Kanagawa,
Japan).
Light Transmission
The FOIS-1 integrating sphere coupled to the USB
4000 fiber-optic spectrometer was used to measure
4 Operative Dentistry

Table 1: Emitted Radiant Power (mW), Calculated Irradiance (mW/cm2), and Radiant Exposure (J/cm2) 6 Standard Deviations
From Each of the Four Light Conditions: Single Standard, Single High, Multi Standard, and Multi High
Polymerization Mode Power (mW) Irradiance (mW/cm2) Radiant Exposure (J/cm2)
Single standard 49.6 6 0.7 1193.8 6 17.6 17.9 6 0.26
Single high 149.9 6 0.7 3607.9 6 16.6 18.04 6 0.08
Multi standard 51.1 6 0.1 1229.9 6 3.2 18.4 6 0.05
Multi high 150.1 6 1.1 3612.7 6 26.0 18.1 6 0.13

the light transmission through the RBC. The RBCs RESULTS

were inserted in a single portion into the same gray
The emitted radiant power, calculated irradiance,
opaque molds used for the degree-of-conversion
and radiant exposure values from each of the four
analysis and covered with Mylar strips. Then they
light conditions are reported in Table 1. The
were pressed between two glass mixing slabs to
emission spectrum and the wavelength peaks of the
produce flat top and bottom surfaces. These molds,
four light conditions are shown in Figure 1. The light
now filled with uncured RBC, were placed at the
beam profiles showed that there was a homogeneous
aperture of the integrating sphere and photoactivat-
distribution of the light through the 2.3-mm aper-
ed at 0-mm distance. SpectraSuite software (Ocean
ture (Figure 2) in all cases.
Optics) was used to record, in real time, the spectral
radiant power transmitted through each RBC. Means and standard deviations of the Knoop
microhardness values at the top of the specimens
After the transmitted spectral radiant power had
are reported in Table 2. Photoactivation with the SS
been measured, the light beam profile through the
light resulted in statistically higher hardness values,
cured specimen was measured using the beam
while photoactivation with the SH light resulted in
profiler camera with a 50-mm-focal-length lens
lower values. Specimens photoactivated with the
(SP620U, Ophir-Spiricon) and a custom-made blue
broad-spectrum lights presented intermediate hard-
filter (International Light Technologies). The molds
ness values. The degree of double-bond conversion
filled with the cured RBC were placed at a fixed
distance from the camera, and the LCU tip was and Knoop microhardness values at the bottom are
placed in contact with the molds. Then the LCU was also reported in Table 2. Filtek Supreme Ultra A2
activated, and the light beam transmitted through photoactivated with the SS light (single-peak blue
the cured RBC was examined. Narrow-band-pass
interference filters that had a maximum bandwidth
centered at 400 or 460 nm and a full-width half-
maximum tolerance of 10 nm (Edmund Industrial
Optics, Barrington, NJ, USA) were used to collect
separate beam profile images of the transmitted
violet and blue lights. The images were collected
using BeamGage version 6.6 software (Ophir-Spiri-
con). Only the high-irradiance-level light conditions
were beam profiled through the different RBCs.

Statistical Analysis
Analysis of variance, followed by the Tukey post hoc
multiple comparison test (a=0.05), was applied. To
determine if there was a statistically significant
difference between the degree of conversion and
Knoop microhardness obtained under the different
light exposure conditions, tests were applied sepa-
rately for each RBC since each RBC has a different
composition. In addition, the Pearson correlation
test was applied to verify if there was a correlation
between degree of conversion and microhardness Figure 1. Emission spectrum, power (mW) and wavelength peaks
measured at the bottom of the specimens. (nm) from the two lights for each of the four light conditions.
Shimokawa & Others: Effect of Curing Light Output on the RBC
Figure 2. Two- and three-dimensional light beam profiles of the lights recorded through the 2.3-mm aperture together with the power (mW) and
scaled irradiance (mW/cm2) using the single high (SH) and multi high (MH) light conditions. The images were taken both without a filter and with either
a 400-nm or a 460-nm 65 nm narrow-band-pass filter and scaled using the power values (mW) calculated from the integrated area under the
emission spectrum (violet 30 mW, blue 120 mW).
light with standard irradiance) achieved a signifi-
cantly higher degree of conversion compared to when
the MH light (multipeak light with high irradiance)
was used, while, when photoactivated with the SH
light (single-peak light with high irradiance) and MS
light (multipeak light with standard irradiance), it
presented intermediate values. The microhardness
at the bottom of the specimen followed the same
trends as the degree-of-conversion results.
Specimens of Tetric EvoCeram A2 and Tetric
EvoCeram T made at the standard irradiance setting
resulted in a higher degree of double-bond conversion
values when either the single-peak blue (SS) or the
broad-spectrum (MS) light was used. The specimens
photoactivated with the SS light showed the highest
degree-of-conversion results at the bottom for the
Tetric EvoCeram A2, but there was no statistical
difference between values obtained with blue light
and broad-spectrum light for the Tetric EvoCeram T.
For the TPH Spectra High Viscosity A2, degree-of-
conversion and microhardness values were not
statistically different for specimens photoactivated
with either the single-peak blue or the broad-
spectrum lights. However, regarding degree of con-
version and microhardness values at the bottom, the
use of lower irradiances resulted in higher values,
while for the top microhardness, specimens photoac-
5
tivated with high irradiances presented higher micro-
hardness values. The Pearson correlation test showed
a significant linear correlation between the degree-of-
conversion and the microhardness values at the
bottom for all the RBCs tested (Figure 3).
The real-time light transmission results showed
that the emitted radiant power that was measured
through the 2.5-mm-thick RBCs was dependent on
the choice of RBC and varied from only about 1.5% to
8% of the power received at the top, depending on the
RBC and the light condition used (Figure 4). The
radiant exposures delivered to the bottom of the
specimen are reported in Table 3. Of the emitted
power, the violet light emitted from the bottom
decreased from about 20% of the total power
delivered to the top, to only 2.5% to 8% of the total
power that was emitted at the bottom (Figure 5). The
light transmission increased with exposure time,
and there was more light transmission through the
translucent Tetric EvoCeram—shade T. The scaled
beam profile images illustrate how little of the violet
light reached the bottom of the specimens (Figure 6).
DISCUSSION
Previous studies compared light curing using differ-
ent designs of single-peak blue and broad-spectrum
lights.21-24 This study allowed better standardization
6 Operative Dentistry

Table 2: Means 6 Standard Deviations for Degree of Conversion at the Bottom (%) and Knoop Microhardness (KHN) for Each
of the Four Light Conditions (ext.)

Top Hardness (KHN) Bottom Hardness (KHN)

Filtek Supreme Tetric TPH Spectra Tetric Filtek Supreme Tetric
Ultra A2B EvoCeram A2 High Viscosity A2 EvoCeram T Ultra A2B EvoCeram A2
Single standard 85.7 6 1.3 A 32.0 6 1.1 B 50.4 6 2.7 B 36.6 6 2.7 B 31.6 6 2.5 A 16.5 6 0.6 A

Single high 79.3 6 2.5 C 31.9 6 1.3 B 63.3 6 2.5 A 29.8 6 2.6 C 29.1 6 2.3 AB 14.7 6 0.8 B

Multi standard 82.0 6 1.8 BC 55.1 6 1.6 A 50.2 6 2.6 B 49.3 6 4.2 A 30.2 6 1.8 AB 15.7 6 1.1 AB

Multi high 83.0 6 1.8 AB 55.6 6 1.7 A 63.0 6 1.5 A 50.2 6 4.1 A 26.8 6 0.5 B 16.3 6 0.2 B

*Statistical differences between light conditions are described with superscript letters, the same letters within a column indicate no significant difference in the value

Figure 3. Scatter graph showing the

correlation between Knoop micro-
hardness and degree of conversion
for the four resin-based composites
for each of the four light conditions (p-
and R2-values indicated for the Pear-
son correlation test).

Figure 4. Percent of maximum pow-

er transmitted in real time through the
2.5-mm-thick specimens for each of
the four light conditions and for Filtek
Supreme Ultra—shade A2B, Tetric
EvoCeram—shade A2, Tetric Evo-
Ceram—shade T, and TPH Spectra
High Viscosity—shade A2. For TPH,
the green line (MS) overlies the black
line (SS). Note how the light trans-
mission through the resin-based com-
posites increased with exposure time.
Shimokawa & Others: Effect of Curing Light Output on the RBC 7

Table 2: Extended.

Bottom Hardness (KHN) Degree of Conversion at the Bottom (%)

TPH Spectra Tetric Filtek Supreme Tetric TPH Spectra High Tetric
High Viscosity A2 EvoCeram T Ultra A2B EvoCeram A2 Viscosity A2 EvoCeram T
Single standard 30.1 6 1.8 A 25.3 6 1.9 A 68.5 6 1.2 A 67.8 6 0.3 A 75.9 6 0.3 A 71.9 6 0.6 AB

Single high 24.7 6 1.8 B 20.6 6 1.5 B 66.6 6 1.7 AB 64.7 6 0.6C 74.3 6 0.3 B 70.4 6 0.5 C

Multi standard 27.0 6 2.2 AB 26.7 6 2.7 A 67.7 6 2.0 AB 66.2 6 1.4 B 75.5 6 0.9 A 72.5 6 0.8 A

Multi high 23.7 6 1.9 B 23.9 6 1.3 AB 65.1 6 1.9 B 65.5 6 0.6 BC 74.0 6 0.3 B 71.4 6 0.5 BC

of the light conditions because both lights used the
same tip and construction, with changes only in the
emission spectra from the LED emitters. The four
light exposure conditions delivered similar radiant
exposures (Table 1), and the standard and high
radiant powers were similar for the single-peak blue
and broad-spectrum lights. The shapes of the emis-
sion spectra was the same for the blue lights, with
peaks at 460 nm, and for the broad-spectrum lights,
with peaks at 400 and 460 nm at both settings (Figure
1). For all conditions, the beam profile of the lights
showed a homogeneous irradiance distribution
through the 2.3-mm aperture. This is relevant since
it is known that the distribution of light can be
inhomogeneous across the light tip, and this inhomo-
geneity may affect resin polymerization.6,18,25 The
distributions of the violet and blue light components
from the LCUs were also homogeneous, as seen in
beam profile images taken through the 400- and the
460-nm narrow-band-pass filters (Figure 2).
The RBCs achieved different microhardness values,
as observed in Table 2, and this can also be noted
observing the different distributions on the scatter
graphs (Figure 3). Tetric EvoCeram A2 achieved the
lowest microhardness values, probably due to the
different formulation of this product. All the RBCs
presented lower microhardness values than expected
at the bottom of the specimens. This likely occurred
due to the optical characteristics of the opaque molds.
The 2.5-mm height is more than the increment
thickness recommended by the manufacturer, and
the opaque gray molds prevented any light transmis-
sion. This should not be considered a limitation of the
study because the aim was to measure not the depth
of cure of the RBCs but rather the influence of the
different exposure conditions on their photoactivation
at a clinically relevant thickness (2.5 mm).
The first null hypothesis was rejected since using
the broad-spectrum lights increased the top micro-
hardness of two RBCs: Tetric EvoCeram A2 and
Tetric EvoCeram T. This result is not unexpected
since the manufacturer states that both of these
RBCs use the alternative photoinitiators and these
initiators are activated by the violet light present in
broad-spectrum lights. Previous studies have also
reported improved properties when RBCs with these
alternative photoinitiators are photoactivated with
broad-spectrum lights.23,26 Consequently, it is rec-
ommended that broad-spectrum lights should be
used to photoactivate RBCs that have alternative
photoinitiators because the top microhardness val-
ues would be enhanced. This should reduce the wear
and better support occlusal loading.
At the bottom of the specimen, there was no
difference between microhardness values when the
single-peak blue or the broad-spectrum lights were
used, even for the RBCs with alternative photo-
initiators in their composition. It might be expected
that RBCs that include only camphorquinone in
their formulation would achieve a higher microhard-
ness when photoactivated with a single-peak LCU
compared to that achieved with a broad-spectrum
LED unit delivering the same radiant power because
more light energy is delivered in the 460 nm region
to the CQ from the single-peak LCU. However, there
was no difference between RBCs photoactivated with
Table 3: Radiant Exposure (J/cm2) Delivered to the
Bottom of the Specimens Made of Each of the
Four Resin-Based Composites, Using Each of
the Four Light Conditions. (Energy Calculated by
Integrating the Area Under the Curve of the Real-
Time Power Graph and Dividing It by the Area of
the Molds)
Filtek Tetric TPH Tetric
Supreme EvoCeram Spectra High EvoCeram
Ultra A2B A2 Viscosity T
A2
Single standard 0.42 0.54 0.31 1.24
Single high 0.40 0.52 0.32 1.23
Multi standard 0.34 0.48 0.31 1.11
Multi high 0.31 0.51 0.29 1.11
8 Operative Dentistry

Figure 5. Radiant power delivered to

the top surface and percentage of this
radiant power from the violet and blue
LEDs that was emitted at the bottom
through 2.5 mm of Filtek Supreme
Ultra—shade A2B, Tetric EvoCer-
am—shade A2, Tetric EvoCeram—
shade T, and TPH Spectra High
Viscosity—shade A2 when using the
broad-spectrum high-irradiance light.
Note the greater light transmission
through the translucent Tetric EvoCer-
am—shade T and the difference in the
transmitted power values compared
to what was delivered to the top.

Figure 6. Scaled two-dimensional

irradiance beam profile images
viewed through 2.5-mm-thick speci-
mens of the four RBCs. The images
were taken without a filter and with
either a 400-nm or a 460-nm 65 nm
narrow-band-pass filter. The images
were scaled using the power values
(mW) calculated from the integrated
area under the emission spectrum.
Shimokawa & Others: Effect of Curing Light Output on the RBC
single-peak or broad-spectrum lights. This probably
occurred because more than sufficient radiant
exposure was delivered within the blue wavelength
range from both lights to photocure the RBCs.
Regarding degree of conversion, except for the
Tetric EvoCeram A2 where specimens photoactivat-
ed with the SS light achieved a significantly higher
degree of double-bond conversion, results were
similar to the microhardness outcomes at the
bottom, with no difference between specimens
photoactivated with single-peak blue and broad-
spectrum lights. This likely occurred because all
the specimens received more than enough energy at
the bottom.
As previously reported, the real-time radiant
power transmitted through these four RBCs in-
creased during polymerization 27; that is, the RBCs
became more transparent as they polymerized
(Figure 3), but it is still greatly reduced compared
to what is delivered to the top surface. Although the
curing lights delivered very similar radiant expo-
sures, the radiant power delivered from the broad-
spectrum lights is a combination of violet and blue
light and thus the light delivered in the blue region
is less compared to the single-peak blue lights. Since
almost none of the violet light reaches the bottom of
the specimen, radiant power delivered in this
spectral region is effectively ‘‘wasted’’ at the bottom,
but not near the top surface. This helps to explain
why the radiant exposure delivered at the bottom of
the Filtek Supreme Ultra specimens was 0.3 J/cm2
when photoactivated with the broad-spectrum lights,
while it was higher (0.4 J/cm2) when the single-peak
blue light was used. The radiant exposure delivered
at the bottom of the translucent shade of Tetric
EvoCeram specimens (1.1 J/cm2 when photoactivat-
ed with the broad-spectrum lights), was also higher
(1.2 J/cm2) when the single-peak blue light was used.
The ratio of blue and violet light transmitted appears
to be affected by the composition of the material
since there was a greater percentage of violet light
transmitted through the Filtek Supreme Ultra A2
than through the other RBCs (Figure 5). This is
likely due to the exclusive use of nanosized filler
particles in Filtek Supreme Ultra that result in less
light scattered in the 400 nm range when compared
to the other RBCs that use larger sized filler
particles. Of note, since twice as much light was
transmitted through the Tetric EvoCeram T than
through the Tetric EvoCeram A2, even though both
were the same brand of RBC, the shade of the
material influences the amount of both blue and
violet light transmission. The increased amount of
9
energy delivered at the bottom of Tetric EvoCeram T
(Table 3 and Figure 4) may explain why there was no
significant difference between degree of double-bond
conversion when using the single-peak blue and the
broad-spectrum lights for this translucent shade,
while there was a significant difference between the
degree of conversion using the same lights for the A2
shade of the same RBC (Table 2).
The reduced transmission of violet light at depth is
a concern if violet light is required to activate some of
the photoinitiators used in the RBC, since the
biocompatibility of restorations is directly correlated
with the degree of conversion of RBCs.15 If the
alternative initiators at the bottom of restorations,
close to the pulp or to the gingival tissues, are not
used up, there may be increased release of unwanted
leachates from the RBC. The concern is that the RBC
may appear to be adequately polymerized if suffi-
cient blue light is delivered to activate the camphor-
quinone photoinitiator, but still may contain the
unused alternative photoinitiators at the bottom.
The second null hypothesis was also rejected.
Equivalent or higher microhardness and degree-of-
conversion values were achieved at the bottom
surface when 1200 mW/cm2 was used compared to
3600 mW/cm2. Not all RBCs responded in the same
manner to the different irradiance levels. This may
be related to the different composition among these
four products, in that they likely have different
polymerization kinetics. High-irradiance photoacti-
vation could potentially cause a lower degree of
conversion because there are more radicals being
formed at the same time, which in turn leads to more
biradical terminations.10 Slower polymerization
rates should produce fewer polymer growth centers,
leading to a higher density of linear chains.28,29 Also,
using a high irradiance should produce polymers
with higher cross-linked density than when using
low irradiance because of the rapid formation of the
polymeric chain. These differences would lead to
different mechanical properties of the material, such
as hardness, but without necessarily altering its
degree of conversion.
It is important to note that the previous studies
that analyzed polymerization kinetics used very low
irradiances,30 from 3.1 to 50 mW/cm2, or very high
irradiances of up to 7500 mW/cm2, while in the
present study,31 the ‘low’ irradiance was close to
1200 mW/cm2, and the higher irradiance was close to
3600 mW/cm2 (Table 1). Thus, the low irradiance
used in the present study should not be considered
low, but instead is a representative standard
irradiance value for contemporary curing lights.
10
The high irradiance levels used in this study are
similar to several high-irradiance light curing units.
The third null hypothesis was rejected since the
Pearson correlation showed a direct linear correlation
between bottom microhardness and degree-of-conver-
sion results (Figure 3). Previous studies have also
reported positive correlations between microhardness
and degree of conversion.32,33 Since these two inde-
pendent tests produced the same outcomes, there is
more confidence in the conclusions of this study.
Considering the results of this study, for shallow
cavities or thin increments, broad-spectrum lights
should be used to photocure RBCs that use alterna-
tive photoinitiators in their composition. When
restoring deeper cavities with a single increment of
composite using a broad-spectrum light, the expo-
sure time should be increased since little violet light
penetrates down to 2.5 mm. The aim is to deliver the
same radiant exposure to the bottom of the compos-
ite as would be delivered using a single peak light.
Regarding the use of high irradiance lights, this
study supports previous reports 9-11 that high
irradiance levels and short (five-second) exposure
times offer no benefit when photoactivating RBC
restorations. Lower irradiance and longer exposure
times may produce RBCs with better physical
properties and are preferable in clinical situations
where small errors in the angle or the position of the
tip of the LCU would have less of a negative effect on
the total amount of energy delivered to the restora-
tion. For example, if one second of exposure was lost
during a five-second exposure of a RBC, this would
represent a decrease of 20% of the total radiant
exposure. If one second of exposure was lost during a
15-second exposure at the lower irradiance values,
this would represent only a 7% decrease in the total
radiant exposure to the RBC.
CONCLUSIONS
Considering the limitations of this study and the
different behaviors of the tested materials, the
emission spectra from the LCUs influenced the
polymerization of the tested RBCs. The microhard-
ness of the materials that used alternative photo-
initiators in their composition was enhanced at the
top surface with the use of broad-spectrum lights.
However, this effect was lost at the bottom surface,
where little violet light was observed. Also, different
shades of the same brand allowed different amounts
of light to reach the bottom of the RBC.
Even when the same radiant exposure was
delivered, the irradiance levels influenced the poly-
Operative Dentistry
merization of the tested RBCs. Equivalent or higher
microhardness and degree-of-conversion values were
achieved at the bottom surface when 1200 mW/cm2
was used compared to 3600 mW/cm2.
Acknowledgements
The authors wish to thank Ultradent for providing the custom
made curing units for this study. They also thank the
University of São Paulo, Santander Bank, and the Dalhousie
Faculty of Dentistry Research Fund for supporting this study.
The manufacturers kindly provided the resin-based compos-
ites for this study.
Conflict of Interest
The authors of this article certify that they have no
proprietary, financial, or other personal interest of any nature
or kind in any product, service, and/or company that is
presented in this article.
(Accepted 18 January 2017)
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